Objectives: We investigated the relationship of serum apolipoprotein E (apoE) levels with dyslipidemia and metabolic syndrome (MS) in the general population and their degree of independence of the apoE genotype.
Study design: This cross-sectional study included a random sample of Turkish adults whose serum apoE concentrations were measured. Metabolic syndrome was defined with the ATP-III criteria with modification for male abdominal obesity.
Results: Of 454 participants (222 men, 232 women; mean age 54.1±9.6 years), the median serum apoE concentration was 3.93 mg/dl with an interquartile range of 1.75 to 5.82 mg/dl. Higher apoE concentrations were found in male carriers of the ε4 allele than homozygous ε3 subjects. Multivariate analysis showed the apoE genotype (grouped into 3) as a determinant of apoE levels, and serum apoB levels as a major covariate. In logistic regression analysis, doubling of the apoE level showed significant associations, independent of the apoE polymorphism, with total cholesterol, elevated apoB (OR 4.54, 95% CI 2.83; 12.3) and triglyceride/HDL-cholesterol dyslipidemia (OR 2.82, 95% CI 1.67; 5.18). Doubling of the apoE level was also associated in both genders with MS (OR 1.72, 95% CI 1.24; 2.38), after adjustment for confounders.
Conclusion: ApoE concentrations in Turkish adults are significantly linked to serum total cholesterol, hyperapoB, and atherogenic dyslipidemia, independent of the apoE polymorphism. They are also significantly and independently associated with MS. Male carriers of the ε4 allele have no lower apoE concentrations than homozygous ε3 individuals, suggesting a close link between apoE and apoB levels.

Objectives: The ICEBERG study (Intensive/Initial Cardiovascular Examination regarding Blood pressure levels, Evaluation of Risk Groups) study focuses on the effect of dyslipidemia on cardiovascular risk evaluation and association of lipid profile with other risk factors.
Study design: The ICEBERG study consisted of two subprotocols: ICEBERG-1, conducted at 20 university hospitals (Referral group) and ICEBERG-2, conducted at 197 primary healthcare centers (Primary Care group). Each subprotocol had two patient profiles: patients previously diagnosed with essential hypertension and under medical treatment (Treated group), and patients with systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, with no antihypertensive treatment for at least three months before inclusion (Untreated group). Dyslipidemia was evaluated and cardiovascular risk stratification performed according to the ESC/ESH 2003 guidelines.
Results: A total of 1817 patients were analyzed. After incorporation of serum lipid values into cardiovascular risk stratification, the percentage of patients in “high” plus “very high” added risk groups increased to 55.2% (p<0.001), 62.6% (p=0.25), and 60.7% (p<0.001) in Treated Referral, Untreated Referral, and Untreated Primary Care groups, respectively. The corresponding figures estimated only by medical history and physical examination were 51.2%, 60.7%, and 54.2%, respectively. Serum lipid levels showed significant correlations with most risk factors.
Conclusion: Serum lipid levels are useful in stratifying hypertensive patients into cardiovascular risk groups more accurately, for appropriate antihypertensive treatment.

Objectives: We investigated the role of physical activity levels in predicting incident coronary heart disease (CHD) and certain metabolic disorders and the possible mediation of abdominal obesity.
Study design: A total of 3248 participants (1601 men, 1647 women; age ≥28 years; mean age 48±12 years) who were enrolled, without a previous diagnosis of CHD, into the Turkish Adult Risk Factor Survey in 1997/98 and 2002/03 were prospectively studied over an eight-year period. Physical activity levels of the participants were categorized as active or sedentary. Metabolic syndrome (MetS) was defined with the ATP-III criteria with modification for male abdominal obesity. Diagnosis of non-fatal CHD was based on history, physical examination, and the Minnesota coding of resting electrocardiograms. The mean follow-up was 6.8 years.
Results: The rates of incident hypertension, diabetes, and MetS were 39%, 8.6%, and 25.4%, respectively. After adjustment for gender, age, and waist circumference, the relative risks (RR) calculated for hypertension (RR 0.76; 95% CI 0.63; 0.91), diabetes (RR 0.66; 95% CI 0.49; 0.89), and MetS (RR 0.76; 95% CI 0.60; 0.97) were significantly lower in the physically active group. Protection offered by physical activity was not mainly mediated by waist circumference or C-reactive protein, since protection from abdominal obesity risk did not reach significance. No influence of physical activity was observed on the risks for developing atherogenic dyslipidemia, elevated LDL-cholesterol, and CHD. Exercise significantly protected men from diabetes, and women from hypertension. Overall, protection from metabolic disorders was similar in both sexes.
Conclusion: Physical activity, adjusted for gender and age, protects Turkish adults from incident hypertension, diabetes, and MetS. This protection is considered to operate mainly through improvements in blood pressure, beyond the mediation of abdominal obesity and low-grade inflammation.

Objectives: Postprandial triglyceride levels are thought to carry greater risk than fasting levels for coronary artery disease (CAD). We investigated the relationship between CAD and fasting and postprandial hypertriglyceridemia in patients with or without metabolic syndrome (MS).
Study design: The study included 122 patients (75 males, 47 females; mean age 59±10 years) whose coronary arteries were examined by coronary angiography within the past six months. The patients were evaluated in four groups according to the presence or absence of CAD and MS, that is, patients, (i) without CAD or MS; (ii) having MS without CAD; (iii) having CAD without MS; and (iv) having both. The diagnosis of MS was made according to the NCEP ATP III criteria. Serum triglyceride levels were measured after 12-hour fasting and at 2, 4, 6, and 8 hours following a lipid loaded breakfast.
Results: Metabolic syndrome and CAD were detected in 49 patients (40.2%) and 51 patients (41.8), respectively. Compared to the patients without MS, fasting and postprandial triglyceride levels were significantly higher at all times in patients with MS (p<0.05), whereas triglyceride levels of patients with and without CAD did not differ significantly (p>0.05). Post-hoc analyses showed that MS was the only factor that affected triglyceride levels significantly.
Conclusion: Our data demonstrate that postprandial triglyceride levels exhibit higher increases and remain high for a longer period in patients with MS, without showing a significant relationship with CAD.

Stenosis formation at anastomotic sites following cardiac transplantation is a rare complication. These strictures can be overcome surgically or percutaneously. A 54-year-old man underwent orthotopic heart transplantation for end-stage dilated cardiomyopathy. Size mismatch between the recipient and the donor resulted in a tight bicaval anastomosis. After seven days postoperatively, the patient developed significant bilateral leg edema. On the tenth postoperative day, he underwent right heart catheterization, and with the injection of contrast material, a stricture was noted at the anastomotic line between the inferior vena cava and the right atrium. The mean pressure gradient at the level of the stenosis was 8 mmHg. The stenotic segment was dilated using a Tyshak II percutaneous valvuloplasty catheter. At the end of the procedure, the mean pressure gradient decreased to 2 mmHg and dilatation was confirmed by venography. Leg edema diminished a few days after the procedure. Hence, the use of a pulmonary balloon catheter for stenotic lesions at the level of anastomosis line between the inferior vena cava and the right atrium yielded a desirable result.

In general, ST-segment elevation in either the precordial or inferior leads is the most common electrocardiography (ECG) finding in patients with acute myocardial infarction (AMI). However, simultaneous ST-segment elevation in the precordial and inferior leads is a rare finding. A 48-year-old male patient was admitted with a diagnosis of AMI upon detection of ST-segment elevation in the DI, aVL, and V1-6 leads and reciprocal changes in inferior leads. A subsequent ECG taken before submission to the cardiac catheterization laboratory showed that the ST-segment approached the isoelectric line in the anterior leads, while remaining elevated in the D2, D3, and aVF leads. Coronary angiography revealed 95% stenosis in the left anterior descending (LAD) coronary artery with total occlusion distally, and some insignificant stenoses in the right coronary artery. A bare metal stent was placed in the LAD, with balloon dilatation of the distal lesion. He was discharged on the seventh day of admission.

Cardivascular diseases are the leading cause of death among patients with end-stage renal disease. Chronic renal failure is not only a known risk factor for commonly seen cardiovascular diseases such as coronary heart disease and left ventricular hypertrophy, but also for some other diseases related to the cardiovascular system such as pericarditis, infective endocarditis, and arrhythmias. Many other diseases that frequently accompany chronic renal failure such as systemic hypertension, hyperlipidemia, homocysteinemia, and hyperparathyroidism contribute to the development of cardiovascular risks. It should be realized that ischemic heart disease may have varying aspects in renal failure with regard to pathophysiology, clinical presentation, and diagnosis. Although treatment approach in these patients is similar to that in general population, dose adjustment of drugs needs special consideration. While chronic renal failure adversely affects the cardiovascular system, it should be noted that heart failure may also have adverse effects on renal functions, most importantly by means of prerenal azotemia. Recently, nephropathy due to radiocontrast dye use in coronary interventions has drawn considerable attention to the relations between these two systems. This review focuses on interactions between renal diseases and the cardiovascular system together with the ensuing detrimental effects and their prevention.

.A 31 year old woman was admitted with weakness, fatigue, dyspnea and fewer. Detailed questioning on past medical history she had undergone of central venous cannulation two weeks previously. Transthoracic echocardiography (TTE) showed a large mobile mass (21×18 mm) attached to the atrial surface of the anterior leaflet of the tricuspid valve with mild tricuspid regurgitation. The diagnosis of infective endocarditis was made and confirmed with blood cultures positive for Staphylococcus aureus septicemia. Vancomycin and gentamycin treatment was started. Repeat TTE on weeks 2 and 4 revealed no changes in the mass. Open heart surgery was performed. Vegetation attached to the tricuspid valve was excited. Tricuspid annuloplasty was performed. Follow up echocardiography disappeared mass and minimal tricuspid regurgitation demonstrated. The patient made an uneventful recovery.